Herpes Recurrences

Answers to Questions about Herpes Outbreaks

What is an outbreak?

Most of the time when herpes sores are not present on the skin the virus remains in a latent state inside some of the nerve root cells, where it does no damage.

When the virus reactivates (or wakes up) it travels nerve paths to the surface of the skin, sometimes causing an “outbreak” or break out of symptoms.

How common are recurrences?

It is certainly possible not to have a recurrence, in fact some people are not even aware that they have herpes. The symptoms vary with each individual and will often depend on the type of HSV (1 or 2) and its location, overall health and the body’s immunity to the virus.
There are also treatments which can significantly help to reduce the chance of having an outbreak. You can read more about some of the options that work well in the Herpes Treatment section.
Symptoms may naturally take longer to show or be less severe in some people, especially in those with partial immunity to the virus. For example, if you already have cold sores this may offer some resistance to genital herpes and vice-versa.
Here are the facts:

  • The most common scenario is to have an occasional recurrence, about 4 times per year or less
  • Approximately 20-40% of HSV-1 seropositive individuals will experience a reactivation of the virus
  • Up to 80% of people who have a first episode caused by HSV-2 will have at least one recurrence
  • The first year after infection usually has the most viral activity

Will I have a re-occurrence?

It is true that most people with herpes have a recurrence but there are many people who don’t. If the symptoms do return, for most people they tend to be less and less severe as time goes on and as your immune system builds up antibodies.
Herpes outbreaks are different for everyone. Even though it is the same virus, it could cause a particular symptoms in one person (such as mild itching and burning) and yet cause completely different symptoms in their partner (such as a small blister or even no symptoms at all).
The typical frequency of a herpes outbreak is four times a year or once every three months. If a person has been infected with the herpes virus it does not necessarily mean that they will ever experience an outbreak or a re-ocurrence.
If you find that you or your loved one’s symptoms are happening regularly take a look at the article How to Reduce Outbreaks for some practical advice that could help to change this.

What is the possibility that I don’t have a recurrence?

Many people do not experience a re-occurrence until months and sometimes even years after their first primary outbreak.
If a recurrence does happen it is sometimes related to a time when the immune system is weakened or under pressure, such as from an illness, stress, poor lifestyle, surgery, etc.
To help reduce outbreaks it is a good idea to pay attention to your body and take some simple precautions that will help to boost your immune resistance. You can learn more about this in the article Herpes and Your Immune System.

Are future outbreaks less severe?

Herpes, for most people, is an occasionally recurrent condition. During a first episode, the immune system develops antibodies and other weapons against the virus. During a recurrence this “immune memory” can help to fight off infection more quickly.

As a result, as time goes on there are usually fewer sores, they heal faster, and the outbreak is less painful. Some people never experience another recurrence.

Can sexual intercourse bring on an outbreak?

Some people find that the friction of sexual intercourse irritates the skin and sometimes triggers a recurrence of symptoms. This is most likely to occur if intercourse is prolonged and vigorous, or if there is insufficient lubrication.
Having less vigorous sex and using a water-based lubricant can help reduce the chances of this happening. Don’t use one that contains the Spermicide nonoxynol-9, as this ingredient can irritate mucous membranes, such as the lining of the vagina. Oil-based lubricants are also a no-no as they weaken latex, making condoms more likely to break.
Even if the friction of intercourse seems to be a trigger for your symptoms, it probably won’t cause a flare-up every time you have sex. It is very important that you refrain from having sexual intercourse or contact with the infected area during an active outbreak, as this could spread the virus as well as prolong your outbreak.

Can the hormonal contraceptive Depro-Provera influence outbreaks?

Yes, it is possible. Research suggests that the contraceptive Depro-Provera can reduce the body’s immune response and therefore your body may become more susceptible to having a herpes outbreak.[1][2][3]

What is the typical cycle of a herpes outbreak?

The symptoms of an active herpes outbreak generally follow a cycle of phases before healing.
If the lesion is in a particularly moist area the healing time may take slightly longer and a scab may not form. However, the lesion should still heal normally and disappear after the outbreak has completed its cycle.
The typical cycle of a herpes outbreak may include:

Inflammation

Swelling, tenderness, burning and redness may appear before the actual outbreak and may include itching and sensitivity. For some people, the inflammation may not progress past this stage or form into blisters.

Blisters or Bumps

This could be one or several small fluid filled lesions, tiny red bumps or a rash that may resemble small fissures (little paper-like cuts), especially near the anus.

Ulcers

When the covering layer of skin on the blister breaks it can form a small, round, wet looking ulcer which may leak a clear to milky colored fluid.

Crust

The sores will normally begin to dry and crust over forming a scab. This is the beginning of the healing process. The virus may still be present during this time and should be considered contagious until the ulcer has completely healed.
The scab will usually fall off naturally and of its own accord once the skin has been repaired underneath. In some cases, particularly where this a lot of moisture, this crusting stage may not eventuate and the wound may heal naturally without forming a scab.

Healing

New skin will form which may look slightly red or silver before completely healing. At this stage the virus has finished its cycle and left the skin’s surface, making it safe to touch again. The virus now retreats back inside the body where it lies dormant and causes no harm.
Healing of the skin does not normally leave scarring. If there is a mark remaining where the outbreak has been, applying a small amount of Aloe vera gel or an essential oil, such as Vitamin E or Rose Hip, can help to repair and restore the skin’s natural color.

Where does the outbreak re-occur?

Typically, if there is a recurrence it will occur in the exact same location as it did previously or closely nearby.

Nerves can have many axons which is why the herpes virus can take a number of pathways to your skin. This is why outbreaks can sometimes appear in different areas nearby to one another.

However, each nerve has a particular area of skin that it serves called a dermatome. The herpes lesions are limited to the dermatome it initially infected unless you autoinnoculate (self-infect) yourself somewhere else.

This means that the outbreaks are limited to the body area where the infection exists (for example, the mouth area) unless you spread the infection somewhere else, such as to the genitals via oral sex, or to another body area through contact with the infection.
This situation is very unlikely. You can learn more about this in the Spreading and Preventing Herpes section.

Is it possible to have little or no symptoms with Herpes?

Yes. The symptoms of genital herpes vary greatly from person to person, with many people having very mild symptoms or even no noticeable symptoms at all (asymptomatic carriers of herpes).

How long does a typical herpes outbreak last?

The duration of a herpes outbreak and the time in between each outbreak can vary depending on the individual and factors such as stress, diet and lifestyle, your immune system and what particular treatment you are using.
The symptoms of a genital herpes infection will typically last from 3 to 14 days, but in some rare cases it may take up to six weeks or so to resolve. The first outbreak is generally the worst for most people and is sometimes followed by a second bout of symptoms shortly after, as the body develops its immune resistance. The duration of a cold sore outbreak will typically last from 2 to 12 days.

What can trigger a recurrent outbreak?

Herpes infections have different patterns in different people, but one thing that does tend to play a part is the state of a person’s health and their immune system.
Below is a list of situations that can sometimes aggravate the herpes virus and bring on an outbreak. These influences do not affect everyone, but it may help you to access possible factors that could be having an effect.
The follow may trigger an outbreak in some cases:

Phyisical Factors:

  • Being run-down
  • Suffering from other genital infections (affecting the local skin area)
  • Menstruation Cycle
  • Pregnancy
  • Drinking a lot of alcohol
  • Exposure of the area to strong sunlight
  • Conditions that compromise a person’s immune system
  • Prolonged periods of stress
  • Fatigue
  • Ultraviolet light
  • Friction or damage to the skin, caused by, for example, sexual intercourse, may also lead to a recurrence
  • Skin irritation (such as sunburn)
  • Surgical trauma
  • Diet and certain foods
  • Another illness (especially with fever)
  • Temperature extremes
  • Steroid medication (e.g., asthma medication)
  • Anything that lowers your immune system or causes local injury can trigger recurrences.

Psychological factors:

  • Emotional upset or stress
  • Periods of prolonged stress can cause more frequent recurrences
  • It is also common to experience stress and anxiety as a result of having recurrences

Many of these factors are associated with time periods when a person’s immune system is weakened or stressed. This makes the body more susceptible to the virus and therefore more likely to experience an outbreak.

References

Where to Now?

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